 |
 |
To Everyone, Received today from Ask the Doctor-Dr. Lieberman of the NPF. I plan to take a copy of this to my neuro. E of the headdress At 08:17 PM 2/25/2001 -0500, you wrote: >***A message from Ask the Doctor*** > >dear friend > pain is part of parkinson disease > please read the following >9 Pain in Parkinson Disease > (1) Introduction > It’s said, “Pain and PD don’t go together.” And when pain appears, its said to be >something else, “arthritis, bursitis, a “bad back”, a “frozen shoulder,” fibromyalgia, a >“pinched nerve,”a sprained muscle, or nerves.” But pain is part of PD, and it has many >forms. In Chapter 1 you met Melvin, the state senator who’s PD started with shoulder pain, >pain his doctor’s attributed to an old football injury. He was treated with anti-inflammatory >drugs, arthritis drugs, acupuncture, exercise, massage, and pain killer to no avail. It wasn’t >until Melvin was diagnosed with PD, and his pain disappeared on Sinemet, that it was >attributed, correctly to PD. In Chapter 5 you learned about discomfort of Restless Legs, a >condition associated with PD. And you learned about the cramping pain of dystonia: neck >pain, leg pain, and arm pain. > How common is pain is PD? In my own experience 50% of people with PD at one >time complain of pain, and in perhaps 50% of them, 25% of all people with PD, the pain is >related to PD and not something else. The pain’s related to PD, if it fits a pattern, if it’s >worse where PD’s worse, if it’s relieved by PD drugs such as Sinemet plus Comtan, if >there’s no other cause. > (2) The Pain of Rigidity > In the beginning, before you’re diagnosed with PD, like Melvin you may complain >of a dull pain, like a sprain. The pain may be described as aching, gnawing, or nagging. The >pain is usually confined to a shoulder, the neck, the back, or a hip. These are either major >weight bearing regions (the back, the hip). Or they’re pivots around which multi- directional >movements occur: side-to-side, up-and-down, back-and-forth, around-and-around. These >pivots are the shoulder, the neck, and to a lesser degree the hip. The elbows and knees are >pivots, but uni-directional movements: back-and-forth (flexion and extension). > This pain is probably related to the rigidity of PD which results in the muscles >becoming stiffer, “less elastic”, harder and more painful for them to move. This type of pain >“magically” disappears when Sinemet plus Comtan or a dopamine agonist is started. > (3) The Pain of Dystonia > Before you’re diagnosed, you may complain of a pain different from Melvin. The >pain may be described as cramping, sharp, stabbing, or throbbing. It’s more intense than >Melvin’s pain. The pain is usually confined to one or both calves, or forearms, or thighs, or >upper arms. This pain is probably related to the dystonia of PD which results in the muscles >becoming hard. This pain also magically disappears when Sinemet plus Comtan or a >dopamine agonist is started. Dystonia is different from rigidity. Although both make the >muscles hard, in rigidity the hardness results from the muscles becoming “less elastic”, >whereas in dystonia it results from the muscles contracting without relaxing. You may not >be able to tell or describe the difference, but a neurologist with an EMG (an >electromyogram, “a cardiogram of the muscle) can. > Dystonia of the calves, forearms, thigh, or upper arms, may be an early symptom of >PD usually in people below age 40 years. It may appear in PD people who are on Sinemet. >Usually it appears as Sinemet “wears off,” typically in the early morning when Sinemet >levels are low. This is called an “off dystonia.” It’s worse on the side more affected by PD. >It’s is treated by adding Comtan or a dopamine agonist to prolong Sinemet’s effect. The >pain of dystonia can appear as Sinemet peaks, called “on dystonia.” It’s harder to treat >requiring re-arranging all your drugs to reduce the “highs” and “lows” of Sinemet. > (4) Describe the Pain > Only you feel the pain, only you can describe it. Be as specific as you can. The >following is helpful. > Location: Where does it hurt most? The shoulder? The Hip? The Back? > Does it stay in one place or does it radiate? If so, where? From the shoulder down >the arm? From the back to the hip? Knowing how a pain radiates, is like knowing the road >on which a car travels. > Intensity: How bad is it? Describe it on a scale from “0" to “10", where “0" is no >pain, and “10" feels like your arm (or leg) was “yanked-off”, or your skin was “ripped off.” >The pain of PD is usually a 4, or 5, or 6, or 7. It’s never a 10. > Duration: There are two parts. > 1. How long have you had the pain? Hours? Days? Weeks? Years? > 2. During a typical day, how long does it last? From the time you get till breakfast? >Till lunch? Till dinner? All day? > Associations: Is the pain associated with discoloration, inflammation, redness, >swelling, or warmth of the overlying skin? The pain of PD shouldn’t be associated with >any of the above. > Position: What, if any, positions make it better. What, if any, make it worse. > Quality: There are many ways to describe pain. Some have special meaning: Words >used include: aching, biting, burning, cramping (like a Charlie-horse) , griping (like being >caught in between a pair of pliers), hurting, nipping, pinching, ripping, smarting, stabbing, >and throbbing. > (5) Unusual Pain > Unusual pain may occur in PD and may be related to muscle spasm (from dystonia) > with pressure on an underlying nerve. Although it’s the muscle that’s in spasm, the pain is >from the nerve. The pain’s more intense than a muscle spasm, and radiates along the nerve. >The following may occur. > Spasm of the piriformis muscle (in the buttock) with pressure on the sciatic nerve >mimicking the pain from a herniated disc. > Spasm of the gastrocnemius muscle (in back of the calve) with pressure on the >peroneal nerve or spasm of the tibialis muscle (in front of the calve) with pressure on the >tibialis nerve causing calve or foot pain. This may be responsible for the intense leg or foot >pain people experience when Sinemet “wears- off.” > Spasm of the pronator muscle in the forearm with pressure on the median nerve, or >spasm of the extensor muscles of the wrist with pressure on the radial nerve with pain down >the forearm. > If spasm of a muscle is the cause of the underlying nerve pain, the treatment is >injecting botulinum toxin into the muscle, reducing the spasm and freeing-up the nerve. > A diffuse, not well localized, burning or throbbing pain may sometimes occur >in an arm or a leg, or across the chest. Whether this is related to PD, or anxiety, or >depression is difficult to pin down. It probably results from a disordered Autonomic Nervous >System. > (6) Treatment > Pain resulting from PD usually respond to PD medication: Sinemet plus Comtan or >a dopamine agonist. Pain that responds in part, or pain that’s not PD, may be treated as such >pain is usually treated. Because many PD people have “sensitive stomachs” (see The >Stomach in Parkinson), I prefer drugs such as Celebrex or Vioxx, drugs that decrease pain >but rarely upset the stomach or cause bleeding. > Anxiety and depression make pain worse, the pain from rigidity, or dystonia, or a > disordered Autonomic Nervous System. Master your anxiety, or your depression > and your pain may disappear. > > > >I also have experienced a lot of muscle cramping in the last year. One >episode even landed me in intensive care on the theory it was heart >problems. They started soon after Sinemet was added to the Mirapex I was >already on. Last week the doctor cut the Mirapex in half to .5 mg. 3 times a >day and kept the Sinemet at 25/100 3 times a day. I have had the first 5 >painfree days in over a year. I wonder if it was a case of over-medication >or a fluke! > > >--- >You are currently subscribed to askthedoctor as: [log in to unmask] >To unsubscribe send a blank email to [log in to unmask] > >